AH1 Exam 3 Urinary/Renal Flashcards Preview

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Flashcards in AH1 Exam 3 Urinary/Renal Deck (229):
1

10^5 CFU/mL

clinically significant UTI, symptoms arise at 10^2-10^3

2

typically identified as the causative microorganism for UTI associated with broad spectrum antimicrobial antibiotic therapy or indwelling catheter

candida albicans

3

fever, chills, and flank pain

indicated UTI in upper urinary tract (involving renal parenchyma, pelvis, and ureters)-pyelonephritis

4

inflammation of renal parenchyma and collecting system

pyelonephritis

5

inflammation of the bladder wall

cystitis

6

inflammation of the urethra

urethritis

7

A UTI that has spread into the systemic circulation and is a life threatening condition requiring emergency treatment

Urosepsis

8

infections that occur in an otherwise normal urinary tract and usually only involve the bladder

uncomplicated UTI

9

infections with coexisting presence of obstruction, stones, or catheters, existing diabetes or neurologic disease, pregnancy induced changes, of a recurrent infection

complicated UTI

10

complications associated with a complicated UTI

pyelonephritis, urosepsis, and renal damage

11

term for a UTI due to original infection not being eradicated

unresolved bacteriuria or bacterial persistance

12

Lower ________ levels cause vaginal atrophy, a decrease in vaginal lactobacilli, and an increase in vaginal pH

estrogen
**Giving women low dose intravaginal estrogen replacement acidifies the vagina and may be effective in treating recurrent UTI**

13

dysuria, frequent urination (+than q2h), urgency, and suprapubic discomfort or pressure
Urine may have blood or sediment

LUT (lower Urinary Tract) infection

14

nonspecific symptoms of UTI

fatigue, anorexia

15

characteristic symptoms of UTI are often absent in which population?

older adults who instead experience non localized abdominal discomfort, cognitive impairment, or generalized clinical deterioration

16

diagnostic study that identifies presence of nitrates, WBCs, and leukocyte esterase in urine

dipstick urinalysis

17

an enzyme present in WBCs that indicates pyuria

leukocyte esterase

18

a voided midstream technique yielding a clean catch urine sample is preferred for obtaining which diagnostic test?

urine culture

19

what do you do with urine after collecting it?

refrigerate it immediately!! and it should be cultured w/in 24 hrs of collection

20

two tests used when obstruction of the urinary system is suspected of causing UTI

intravenous pyelogram (IVP)
Cytoscopy
Renal ultrasound is preferred urinary tract imaging technique if recurrent UTI, bc it is noninvasive, easy to perform, and relatively inexpensive

21

Uncomplicated UTI antibiotics

Bactrim, Septra (trimethoprim-sulfamethoxazole)
Nacrodantin, Macrobid (nitrofurantoin)
short-term 1-3 days

22

Antibiotics 7-14 days or longer
Bactrim or Macrobid
Ampicillin, amoxicillin, first gen cephalosporin, fluoroquinolone
consider 3-6 mons trial of suppressive or prophylactic antibiotic regimen
consider post coital antibiotic prophylaxis (Bactrim, Macrobid, or Cephalexin)
adequate fluid intake

Complicated UTI treatment

23

Nitrofurantoin (Macrodantin, Macrobid) patient teaching

avoid sunlight, notify HCP if fever, chills, cough, chest pain, dyspnea, rash or numbness or tingling of fingers or toes develops

24

debilitated persons, older adults, patients who are immune compromised due to co-morbid disease (CA, HIV, DM), and patients treated with immunosuppressive agents or corticosteriods

Are at increased risk of UTI

25

hyper/hypothermia, decreasing BP, rapid pulse and RR, warm flushed skin

report to HCP as these may indicate septic shock r/t urosepsis

26

benefits of increased fluid intake during UTI, pyelonephritis

fluids will increase frequency of urination at first, but will also dilute the urine, making the bladder less irritable. Fluids will help flush out bacteria before they colonize in the bladder.

27

Caffeine, alcohol, citrus juices, chocolate, and highly spiced foods or bevs

should be avoided during UTI as they are irritating to the bladder

28

nonpharmacological relief of UTI

heating pad, warm shower, sitz bath

29

commonly starts in renal medulla and spreads to renal cortex

pyelonephritis

30

mild fatigue, sudden onset of chills, fever, vomiting, malaise, flank pain, and the LUTs of cystitis (dysuria, urgency, frequency).
Costovertebral tenderness is usually present on the affected side
these manifestations usually subside within a few days (even without treatment) but bacteriuria and pyuria persist

Acute pyelonephritis

31

CBC shows leukocytosis and a shift to the left with an increase in immature neutrophils (bands)

acute pyelonephritis

32

kidneys have become small, atrophic, and shrunken and have lost fxn owing to scarring or fibrosis. Usually the outcome of recurrent infections of upper urinary tract

Chronic pyelonephrits (AKA interstitial nephritis, chronic atrophic pyelonephritis, or reflux nephropathy)

*if both kidneys are involved, often progresses to ESRD

33

how do you diagnose chronic pyelonephritis?

*radiologic imaging-indicate small, contracted kidney with thinned parenchyma; collecting system may be small or hydronephrotic
*histologic testing-

34

trichomona, monilial infection, chlamydial infection and gonorrhea

typical causes of urethritis

35

trimethoprim/sulfamethoxazole and nitrofurantoin

drugs for bacterial infections of urologic origin

36

Flagyl and Mycelex

treat Trichomonas

37

nystantin (Mycostatin), Diflucan

monilial infections

38

doxycycline (Vibramycin)

chlamydial infection

39

teach patients with sexually transmitted urethritis to refer their sexual partner(s) for evaluation and testing if they have had sexual contact in the last ____ days

60

40

the result f obstruction and subsequent rupture of the periurethral glands into the urethral lumen with epithelization over the opening of the resulting periurethral cavity

urethral diverticula (mostly occurs near Skene's glands which are the largest and most distal glands along the urethra)

41

dysuria, post void dribbling, frequent urination, urgency, suprapubic discomfort or pressure, dyspareunia, and a feeling of incomplete bladder emptying; urinary incontinence is common; urine may contain gross hematuria and sediment (cloudy); an anterior vaginal wall mass may be noted on physical exam and the mass may be tender and expel purulent discharge through urethra when palpated.

urethral diverticula (1:4 women will have no symptoms)
Voiding Cystourethrography (VCUG)
UA, MRI to determine size of diverticulum

42

condition suspected whenever a pt experiences symptoms of a UTI but tests are neg for bacteria or pyuria

IC/PBS
Interstitial Cystitis/Painful Bladder Syndrome:


43

avoid acidic foods: citrus, aged cheese, nuts, vinegar, curries, hot peppers +tea, coffee, alcohol, soda
take calcium phosphorus supplements

bladder irritating foods and dietary recommendations (esp for IC/PBS)

44

Elavil and Aventyl are used to decrease burning pain and urinary frequency
Pentosan (Elmiron) is only oral agent approved for tx of IC-enhances protective effects of glycosaminoglycan layer of the bladder
drugs do not provide immediate relief!!** for that, give opioid analgesics!
instill Dimethylsulfoxide (DMSO) directly into bladder to desinsitize pain receptors in the bladder wall.
Heparin and hyaluronic acid may also be instilled in bladder
Instillations are often administered with Lidocaine
Bacille Calmette-Guerin is an attenuated form of Mycobacterium bovis, and is another common tx.

medication mgmt IC/PBS

45

affects both kidneys equally and is the third leading cause of renal failure in US

glomerulonephritis

46

SLE, systemic sclerosis (scleroderma), streptococcal infection

common causes of glomerulonephritis

47

accumulation of antigen, antibody, and complement in the glomeruli:
Anti-GBM antibodies
lumpy bumpy deposits in renal tissue

glomerulonephritis

48

hematuria and urinary excretion of RBCs, WBCs, and casts. Proteinuria, and elevated BUN/Cr

clinical manifestations of glomerulonephritis

49

develops 5-21 days after infection of the tonsils, pharynx, or skin (streptococcal sore throat, impetigo) (group A beta hemolytic strep)

Acute Poststreptococcal glomerulonephritis-due to complement clogging glomerulus

50

generalized body edema, hypertension, oliguria, hematuria with a smoky or rust appearance (indicative of bleeding in upper urinary tract), and proteinuria. Fluid retention (due to decreased glomerular filtration); abdominal or flank pain possible

Acute Poststreptococcal glomerulonephritis-

51

an immune response to streptococcus is usually demonstrated by assessment of

ASO titers (antistreptolysin-O)
which will reflect a decrease in complement componenets of C3 and CH50

52

renal biospy

to confirm Acute Poststreptococcal glomerulonephritis-

53

erythrocyte casts are usually indicative of __________ if found in dipstick urinalysis

Acute Poststreptococcal glomerulonephritis-

54

rest (address proteinuria, hematuria), sodium and fluid restriction (to address edema), diuretics (to address edema), anti-HTN therapy, adjustment of dietary protein (if BUN is elevated-to decrease nitrogenous waste in urine)

tx for Acute Poststreptococcal glomerulonephritis-

55

a cytotoxic autoimmune disease characterized by the presence of circulating antibodies against glomerular and alveolar basement membrane

Good Pasture Syndrome-seen mostly in young male smokers

56

flulike symptoms with pulmonary symptoms of cough, milk SOB, hemoptysis, crackles, rhonchi, and pulmonary insufficiency. hematuria, weakness, pallor, anemia, and renal failure

clinical manifestations of Good Pasture's Syndrome

57

corticosteroids, immunosuppressive drugs (Cytoxan, Imuran), plasmapheresis, and dialysis

tx for good pasture syndrome, rapidly progressive glomerulonephritis

58

HTN, edema, proteinuria, hematuria, and RBC casts

rapidly progressive glomerulonephritis

59

proteinuria, hematuria, and slow development of uremia

Chronic glomerulonephritis: protein and phosphate restrictions may slow disease progression

60

when the glomerulus is excessively permeable to plasma protein, causing proteinuria that leads to low plasma albumin and tissue edema

Nephrotic Syndrome

61

peripheral edema, massive proteinuria, HTN, hyperlipidemia, hypoalbuminemia, decreased serum albumin, decreased total serum protein, and elevated serum cholesterol; hypocalcemia, blunted calcemic response to parathyroid hormone, hyperparathyroidism, and osteomalacia

Nephrotic Syndrome

62

What causes hyperlipidemia?

the diminished plasma oncotic pressure from the decreasaed serum proteins (nephrotic syndrome) stimulates hepatic lipoprotein synthesis-->hyperlipidemia

63

nephrotic proteinuria (nephrotic syndrome) leads to

loss of clotting factors resulting a hypercoagulable state

64

serious complication of nephrotic syndrome

hypercoagulability with thromboembolism

65

ACEI's, NSAIDS, low sodium, low protein
if severe, consider corticosteriods and cyclophosphamide

tx for nephrotic syndrome

66

Nursing interventions r/t edema

weight pt daily, monitor I&Os, measure abdominal girth or extremity size

67

risk for imbalanced nutrition: less than body requirements

nephrotic syndrome from excessive loss of protein in the urine. serve small, frequent meals in a pleasant setting

68

struvite

stones assoc with UTI (magnesium ammonium phosphate)

69

abnormalities that result in increased urine levels of calcium, oxaluric acid, uric acid, or citric acid

metabolic risk factors for the development of urinary tract calculi

70

large intake of dietary proteins that increases uric acid excretion
excessive amounts of tea or fruit juices that elevate urinary oxalate level
large intake of calcium and oxalate

dietary risk factors for the development of urinary tract calculi

71

abdominal or flank pain, hematuria, and renal colic

clinical manifestations of urinary stones

72

sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads

foods high in purine (avoid if uric acid stones)

73

milk, cheese, ice cream, yogurt, all beans except green beans, lentils, fish with fine bones (sardines, kippers, herring, salmon), dried fruits, nuts, ovaltine, chocolate, cocoa

food high in calcium (avoid if calcium stones)

74

drak roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, buts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, ovaltine, worcestershire sauce, tea

food high in oxalate

75

all voided urine should be strained through gauze or urine strainer

pts with urinary stones

76

hypertension, hematuria, feeling of heaviness in the back, side or abdomen, chronic pain, bilateral, enlarged kidneys are palpable

polycystic kidney disease, a hereditary renal disease characterized by a cortex and medulla filled with large, thin walled cysts that enlarge and destroy surrounding tissue by compression.

77

which type of urinary incontinence is more common in men?

overflow incontinence

78

which types of urinary incontinence are more common in women?

stress and urge incontinence

79

urinary leakage and post void dribbling

overflow

80

normal PVR (post void residual)

50-75 mL
repeat measurement if you get a finding over 100mL

81

Abnormal PVR in older client

>200mL obtaining on two separate occasions and will require HCP attention

82

urinary retention is caused by two different dysfunctions of the urinary system:

1) bladder outlet obstruction (enlarged prostate)
2) deficient detrusor (bladder) muscle contraction strength (caused by childbirth, DM, overdistention, chronic alcoholism, anticholinergics)

83

sudden increase in intrabdominal pressure causes involuntary passage of urine (coughing, laughing, sneezing, heavy lifting, exercising

Stress Incontinence
tx: Kegels, weight loss if obese, cessation of smoking, topical estrogen

84

condition occurs randomly when involuntary urination is preceded by urinary urgency. Overactive bladder, nocturnal frequency and incontinence are common

urge incontinence
Treat underlying cause
bladder retraining with urge suppression, decrease in dietary irritants, bowel regularity, and kegels
administer anticholinergics, CCBs, or Tofranil at bedtime

85

what causes urge incontinence?

uncontrolled contraction or overactivity of detrusor muscle (CNS d/os, CVA, alzheimers, brain tumor, parkinsons, interstitial cystitis)

86

condition occurs when the pressure of urine in overfull bladder overcomes sphincter control; bladder remains distended and is usually palpable

overflow incontinence
urinary catheterization to decompress bladder
implement Crede or Valsalva maneuver
alpha blockers Cardura, Flomax
bethanechol to enhance bladder contractions

87

what causes overflow incontinence?

bladder or urethral outlet obstruction or underactive detrusor muscle caused by myogenic or neurogenic causes (herniated disc, diabetic neuropathy)
may occur after anesthesia and surgery
neurogenic bladder (flaccid type)

88

condition occurs when no warning or stress precedes periodic involuntary urination.

Reflex Incontinence
Treat underlying cause
bladder decompression to prevent ureteral reflux and hydronephrosis
intermittent self cath
diazepam and baclofen to relax external sphincter
prophylactic antibiotic

89

What causes Reflux incontinence?

spinal cord lesion above S2 interferes with CNS inhibition resulting in detrusor hyperreflexia and interferes with pathways coordinating detrusor contraction and sphincter relaxation

90

loss of urine resulting from cognitive, functional or environmental factors

functional incontinence
modifications of environment or care plan that facilitate regular, easy access to toilet and promote patient safety

91

penile compression device

must be released hourly to void

92

drugs to decrease bladder spasms

oxybutynin or other oral antispasmodics or belladonna and opium

93

irrigating a nephrostomy tube

no more than 5mL sterile saline solution at one time to prevent overdistention of the kidney; infection and kidney stones are complications assoc with nephrostomy tubes

94

inserting a urethral catheter q3-5h; somtimes only twice a day to measure residual volume and to ensure empty bladder

intermittent catheterization

95

how frequently do you change a catheter?

q7days

96

most common cause of acute kidney injury

acute tubular necrosis

97

most common cause of chronic kidney disease

diabetic nephropathy

98

diagnostic criteria for acute kidney disease

acute reduction in urine output and/or elevation in serum Cr

99

diagnostic criteria for CKD

GFR 3mos and/or kidney damamge > 3mos

100

Kidney failure results in an inability to excrete ______ and ____ as well as contributing to disturbances of all body systems

metabolic waste and water

101

an accumulation of nitrogenous waste products (urea nitrogen and creatinine) in the blood

azotemia

102

AKI develops over hours or days with progressive elevations of ____, ______, and _____

BUN, Creatinine, and potassium

103

factors external to the kidneys that reduce systemic circulation causing a reduction in renal blood flow, and lead to decreased glomerular perfusion and filtration of the kidneys.

Prerenal causes of AKI
hypovolemia, decreased CO, Decreased PVR, decreased renovascular blood flow

104

Why might renovascular blood flow diminish?

bl renal vein thrombosis
embolism
hepatorenal syndrome
renal artery thrombosis

105

Prerenal azotemia results in

a reduction in the excretion of sodium (less than 20 mEq/L) increased salt and water retention, and decreased urine output due to activation of angiotensin II, aldosterone, NE, and ADH

106

Prerenal conditions account for many cases of

intrarenal AKI bc if the decreased perfusion persists for an extended period of time, the kidneys lose their ability to compensate and damage to renal tissue occurs

107

What damages intrarenal function?

prolonged ischemia, nephrotoxins (aminoglycoside antibiotics, contrast medium), hemoglobin released from hemolyzed RBCs, or myoglobin released from necrotic muscle cells

Primary renal disease such a acute glomerulonephritis, acute tubular necrosis, or SLE may also cause AKI

108

Most common cause of intrarenal AKI

Acute tubular necrosis

109

what causes Acute tubular necrosis?

ischemia, nephrotoxins, or sepsis

110

what causes postrenal causes of AKI?

mechanical obstruction in the outflow of urine
BPH
bladder CA
Calculi formation
neuromuscular d/o
prostate CA
spinal cord disease
strictures
trauma to back, pelvis, or perineum

111

Where does the urine goes if obstructed?

it refluxes into renal pelvis, impairing kidney fxn

112

kidney dilation

hydronephrosis (due to BL ureter obstruction and urine builds up in renal pelvis)

113

phases of AKI

oliguria-high urine specific gravity, hyperkalemia, hypervolemia *give only enough fluids in oliguric phase to replace losses (400-500mL/24hrs)
diuretic (low urine specific gravity (<1.020g/mL), hypokalemia, hypovolemia
recovery: everything returns to normal

114

RIFLE standardizes the diagnosis of AKI

Risk (serum Cr increases X1.5 or GFR decreased by 25%
Injury CrX2 or GFR decreased by 50%
Failure CrX3 or GFR decreased by 75% or Cr>4mg/dL
Loss persistent Acute Kidney Failure; complete loss of kidney fxn if >4wks
End Stage Renal Disease complete loss of kidney fxn > 3 mos

115

less than 400mL/day or urine

oliguria; urine specific gravity will be high (>1.020g/mL)

116

typical duration of oliguria phase of AKI

10-14 days but can last for months in some cases

117

the longer the oliguric phase

the poorer the prognosis for complete recovery of kidney fxn

118

anuria

often seen in urinary obstruction (postrenal failure)

119

oliguria

often seen in prerenal failure

120

nonoliguric AKi

seen with Acute interstitial nephritis and ATN

121

anuria and oliguria can lead to

JVD, edema, HTN, fluid overload, HF, pulmonary edema, pleural effusions

122

In kidney failure, the kidneys cannot synthesize

ammonia which is needed for hydrogen excretion leading to metabolic acidosis (bicarb is used up trying to neutralize the hydrogen ions that can't be excreted)--> Kussmaul respirations

123

(with regard to AKI) uncontrolled hyponatremia or water excess can lead to

cerebral edema

124

(With regard to AKI) What happens to potassium in AKI?

kidneys cannot excrete potassium--> hyperkalemia
compounded by massive tissue trauma bc damaged cells release addt'l potassium into ECF.
PLUS bleeding and blood tranfusions may cause cellular destruction, releasing MORE potassium into ECF
FINALLY, Acidosis worsens hyperkalemia as hydrogen ions enter the cells and potassium is driven out of the cells into the ECF

125

peaked T waves, widening QRS complex, and ST depression

hyperkalemia

126

What happens to the blood with AKI?

leukocytosis-the most common cause of death with AKI is INFECTION (in urinary and respiratory systems)

127

AKI with leukopenia and thrombocytopenia indicate

etiology of SLE or thrombotic thrombocytopenic purpura

128

A CBC with esinophilia in a pt with AKI indicates

etiology of allergic response and presence of interstitial nephritis

129

an end product of endogenous muscle metabolism

creatinine

130

end product of protein metabolism

urea

131

BUN and Cr are __________ in AKI

elevated

132

what does an elevated BUN indicate?

dehydration, corticosteriods, catabolism r/t infections, fever, severe injury, or GI bleeding, thus elevated Cr is more indicative of AKI

133

fatigue, difficulty concentrating which escalates to seizures, stupor, and coma
Asterixis

neurologic changes that occur as nitrogenous wastes accumulate in brain and other nervous tissue

134

flapping tremor when the wrist is extended

Asterixis

135

What happens during the diuretic phase of AKI?

kidneys have regained ability to excrete waste, but not to concentrate urine in the tubules and thus hypotension and hypovolemia result from the massive fluid losses (3-5L/day!)

136

How long does diuretic phase of AKI last

1-3 weeks

137

What happens in the recovery phase of AKI?

GFR increases, allowing the BUN/Cr to plateau then decrease. Major improvements occur within 1-2 weeks of this phase, but kidney fxn may take up to 12 mos to stabilize

138

dehydration, blood loss, severe heart disease

prerenal causes of AKI

139

nephrotoxic drugs, recent blood transfusion, or radiologic study using contrast media

intrrenal causes of AKI

140

stones, BPH, CA of bladder or prostate

postrenal causes of AKI

141

Urine sediment (obtained in urinalysis) containing abundant casts, cells, or proteins (hematuria, pyuria, and crystals) suggest

intrarenal disorder

142

urine sediment may be normal in

prerenal and postrenal AKI

143

assess abnormalities in kidney blood flow, tubular fxn, and the collecting ststem

renal scan

144

identify lesions and masses , obstructions or vascular abnormalities in kidney

CT scan

145

administration of contrast medium gadolinium (used primarily in MRA) has been associated with the development of

nephrogenic systemic fibrosis: cutaneous hyperpigmentation and induration and joint contractures

146

diagnosis of intrarenal cause of AKI

renal biopsy

147

during the oliguric phase, monitor fluid intake closely. fluid restrictions often are

600mL plus previous 24 hr fluid loss

148

what temporarily shifts potassium back into cels during hyperkalemia?

insulin and sodium bicarb

149

what rises threshold at which hyperkalemia related dysrhythmias will occur?

calcium gluconate

150

what removes potassium from the body during aki and hyperkalemia?

kayexalate and dialysis

151

when is kayexalate contraindicated?

paralytic ileus bc bowel necrosis may occur

152

What is RRT?

renal replacement therapy
intermittent Hemodialysis
Continuous hemodialysis (CRRT over 24 hours-slowly)
peritoneal dialysis

153

When do you institute RRT?

1) volume overload causing compromised cardiac/respiratory fxn
2) elevated serum potassium
3) metabolic acidosis (bicarb 120mg/dL
5)significant change in mental status
6) pericarditis, pericardial effusion, or cardiac tamponade

154

what to consider when giving iv insulin for elevated k+?

give glucose iv concurrently to avoid hypoglycemia

155

how do you give kayexalate?

by mouth or retention enema; mixed in water with sorbitol to produce osmotic diarrhea, allowing for evacuation of potassium rich stool from the body

156

What might you hear in a heart with aKI

s3 gallop, murmurs, pericardial friction rub

157

dont give a patient with renal d/o a contrast medium diagnostic study. If you cant avoid it...

ensure optimal hydration using bicarbonate solution or sodium chloride with or without the prophylactic administration of mucomyst

158

1 kg =

1000 ml of fluid

159

what causes stomatitis?

ammonia excess in saliva irritates mucus membranes

160

stage 1 CKD

GFR >90mL/min/1.73^m2

161

Stage 2 CKD

GFR 60-89 mL/min/1.73^2

162

Stage 3 CKD

GFR 30-59 Moderately decreased GFR

163

Stage 4 CKD: prep for RRT

GFR 15-29 severe decrease in GFR

164

Stage 5 CKD

GFR <15 or dialysis required KIDNEY FAILURE

165

two main causes of CKD

diabetes, HTN

166

a syndrome in which kidney function declines to the point that symptoms develop in multiple body systems

Uremia in CKD
GFR <10mL/min

167

n/v, lethargy, fatigue, impaired thought processes and HA

elevated BUN

168

CKD: Altered carb metabolism

due to impaired glucose use resulting from cellular insensitivity to the normal action of insulin-->hyperglycemia and hyperinsulinemia

169

insulin depends on the kidneys for excretion, therefore, diabetics with CKD may need ______ insulin than before the onset of CKD

less

170

hyperinsulinemia stimulates hepatic production of

triglycerides
therefore, almost all pts with uremia develop dyslipidemia r/t decreased levels of lipoprotein lipase that is important in the breakdwn of lipoproteins. This means that many pts with CKD die of Cardiovascular disease.

171

what serum potassium level is fatal?

7-8

172

If you are retaining sodium in renal failure, then why do you have hyponatremia and not hypernatremia?

bc of the excessive amount of fluid--dilutional hyponatremia

173

what is the sodium restriction for CKD

2g/day

174

absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, and respiratory failure

hypermagnesemia in CKD

175

which type of anemia is associated with CKD?

normocytic, normochromic anemia. due to decreased production of erythropoietin by the kidneys.
nutritional def's, decreased RBC lifespan, increased hemolysis of RBC, frequent blood samplings, and bleeding from GI tract add to anemia

176

What about PTH and CKD?

parathyroid hormone is increased in CKD to compensate for decreased Ca++ and HD. PTH inhibits erythropoeisis, shorten survival of RBCs and cause bone marrow fibrosis
PTH stimulated bone demineralization (increased fractures) to release Ca++ from bones, but this releases phosphate too and phosphate decreases vit D activation by kidneys too.

177

What about iron in CKd?

folic acid, essential for RBC maturation, is dialyzable bc it is water soluble. Give folic acid 1mg/day

178

Why is there so much bleeding with uremia and CKD?

defect in platelet fxn-impaired platelet aggregation and impaired release of platelet factor III. Alterations in the coagulation system with increased concentrations of factor VIII and fibrinogen=bleeding

179

Why do pts with CKD get so many infections?

decreased leukocyte production (enlarged spleen) as well as hyperglycemia and use of catheters, needle insertions, etc

180

which would you expect to see in a HD pt? left or right sided HF?

Left sided, esp left ventricular hypertrophy due to so much fluid to overcome to pump out

181

friction rub, chest pain, low grade fever

pericarditis

182

why is serum calcium low in CKD?

as kidney fxn deteriorates, less vit D is converted to its active form, resulting in decreased serum levels. To absorb Ca++ from GI tract, activated vit D is needed. Thus decreased active vit D levels result in less Ca++ absorption from GI and therefore decreased serum Ca++

183

CKD mineral and bone disorder

adds to morbity and mortaltiy risks bc the phosphate and calcium released from bone by PTH bind together and deposit on walls of vasculature (this may occur in the heart and disrupt conduction)

184

what happens to the skin with CKD?

pruritis, itchy, dry, uremic frost

185

first indication of kidney damage

proteinuria-do dipstick eval of protein in urine or evaluation for microalbuminuria (not detected on routine urinalysis)

186

a ratio greater than 300 mg albumin per 1 g Cr

signals CKD

187

meds for CKD

erythropoeitin therapy
calcium supplements and/or phosphate binders, iron
anti-HTN meds
ACEIs or ARBs
statins for hyperlipidemia

188

when do you take phosphate binders?

with meals

189

when do you take calcium supplements?

on an empty stomach, but NOT with iron

190

when do you take iron?

between meals

191

dyspnea, tachypnea, and SOB

indicators of fluid excess

192

what is dialysis for

to correct fluid and electrolyte imbalances in pts with kidney failure

193

Which dialysis is preferrable for a diabetic CKD patient?

Peritoneal dialysis

194

inflow (10 mins) , dwell (20-30 mins), drain (15-30mins)

PD

195

why implant an AVG over AVF?

history of IV drug abuse, obesity, or PVD

196

when can you use an AVF?

4-6 weeks, but recommendation is 3 months

197

when can you use AVG?

2-4 weeks

198

what is steel syyndrome

development of distal ischemia r/t HD access

199

Where do you access for HD while waiting for AVF or AVG?

Internal jugular or femoral percutaneous cannulation
1-3 weeks if in jugular, only 1 week in femoral

200

how do you treat hypotension during dialysis?

decrease volume of fluid being removed and infuse NS

201

What two nutritional supplements do you commonly give pts with CKD?

calcium and iron (iron causes constipation)

202

What happens to Hgb when dehydrated?

Hgb increases when dehydrated

203

dizziness, weakness, cardiac irregularities, muscle cramps, diarrhea, nausea

hyperkalemia (during oliguric phase)-->avoid giving pts with renal insufficiency potassium sparing diuretics, potassium supplements, or salt substitutes
use LASIX instead

204

fatigue, anorexia, dyspnea, nocturia, 1+pedal edema, basilar crackles in both lungs, clear pale urine, yellow gray pallor (due to anemia or uremia) bruising and uremic frost

ESRD

205

What is protein restricted in renal patients

to reduce the accumulation of waste products associated with protein metabolism, which causes the manifestations of uremia. allowed proteins should be of high biologic value, such as eggs. Fluid allowances should be 500-600mL more than the previous days 24 hr urine output.

206

What is a big risk for HD patients?

could get hepatitis
AIR EMBOLUS
hypotension

207

What about weight gain and dialysis patients?

weight gain between dialysis should not exceed 1.5 kg

208

Nursing considerations for patient post op for kidney transplant?

Priority nursing diagnosis is risk for infection bc immunosuppressant meds are prescribed to decrease organ rejection, but also increase risk for infection. NO FLOWERS in patient room and frequent hand washing performed by all visitors
Azathioprine (Imuran)
Cyclosporine (Sandimmune)
Solu-Medrol

209

kidney pan, oliguria or anuria, HTN, lethargy, fever and fluid retention, increased BUN/Cr, increased Potassium

symptoms indicative of organ rejection

210

occurs within the first 48 hours of transplantation and requires immediate removal of transplanted kidney

hyperacture rejection

211

occurs up to 2 years after surgery, most commonly within first 2 weeks. It can often be managed effectively with increased doses od immunosuppressice meds

acute rejection

212

a gradual process, occurring or a period of months to years. Conservative mgmt, including a careful balance of fluid and protein intake helps control the rejection, but the eventual outcome is the need for dialysis

chronic rejection

213

raises BP as a result of angiotensin (local vasoconstriction) and aldosterone (volume expansion) secretion

renin produced in kidney

214

regulate intrarenal blood flow by vasodilation or vasoconstriction

prostaglandins produced by kidney

215

increase blood flow (vasodilation) and vascular permeabilty

bradykinins produced in kidney

216

stimulates bone marrow to make RBC

erythropoietin make in kidney

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promotes absorption of calcium in the GI tract

Activated Vit D by kidney

218

makes DCT and CD permeable to water to maximaize reabsorption and produce a concentrated urine

ADH aka vasopressin (influenced by renal fxn) comes from posterior pituitary

219

promotes sodium reabsorption and potassium secretion in DCT and CD; water and chloride follow sodium

aldosterone (influenced by renal fxn) comes from adrenal cortex

220

cause tubular secretion of sodium

natriuretic hormones (influenced by renal fxn but made in cardiac atria and brain)

221

what is a nursing consideration for phosphate binders such as amphogel, alternaGEL?

aluminum toxicity may cause bone disease and dementia

222

nausea, vomiting, anorexia, visual disturbances, restlessness, HA, cardiac dysrhythmias, bradycardia

digoxin toxicity

223

nursing considerations for Epogen

monitor Hct weekly-no more than 4 point increase in less than 2 weeks
explain that pelvic and limb pain should dissipate in 12 hours
dont shake vial as that mat inactivate glycoprotein

224

renal osteodystrophy

abnormal calcium metabolism causes bone pathology

225

What diagnostic tests allows you to determine kidney function?

IVP Intravenous Puelogram

226

Which diagnostic test allows you to determine bladder function?

Cystogram

227

Which diagnostic test allows you to determine bladder or urethral abnormalities?

Cystoscopy

228

What is a key patient teaching regarding resolution of aUTI?

Tell the client to be diligent about taking antibiotics around the clock and to not skip doses in order to keep blood level of antibiotic constant for optimal effectiveness.

229

a needle or catheter is inserted through the skin into the calyx of the kidney. The stone may be dissolved by percutaneous irrigation with a liquid that dissolves the stone or by ultrasonic sound waves (lithotripsy) that can be directed through the needle or catheter to break up the stone, which can then be eliminated through the urinary tract.

percutaneous nephrostomy